Provider Demographics
NPI:1619559507
Name:BUSHART, JAMEILA NICOLE
Entity Type:Individual
Prefix:
First Name:JAMEILA
Middle Name:NICOLE
Last Name:BUSHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 BERGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4603
Mailing Address - Country:US
Mailing Address - Phone:517-580-1142
Mailing Address - Fax:
Practice Address - Street 1:3503 BERGMAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4603
Practice Address - Country:US
Practice Address - Phone:517-580-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant